Abstract WP220: Determinants for Cryptogenic Stroke: Clinico-radiologic Findings
Background: Cryptogenic stroke accounts for 30-40% of all strokes. Aortic arch atheroma(AAA), patent foramen ovale(PFO) and paroxysmal atrial fibrillation(PAF) are common causes which require different treatment strategies. However not all patients could undergo extensive work-ups. We investigated clinico-radiological characteristics of these 3 common causes of cryptogenic stroke to find a model helping decision-making.
Method: We enrolled 194 patients with cryptogenic stroke at the time of admission. After performing extensive work-ups including electrocardiography, transthoracic or transesophageal echocardiography, transcranial right-to-left shunt test, coronary computed tomography angiography or cardiac telemetry, patients were allocated into 3 groups; (1) AAA(n=25), (2) PFO(n=94), and (3) PAF(n=75). Vascular risk factors and findings on diffusion-weighted image were analyzed.
Results: Clinico-radiologic features were different. Patients with PFO were younger (mean, 56.1[PFO] vs. 73.9[AAA] vs. 70.6[PAF] years; p<0.001) and hypertension was less common (p<0.001). Smoking was more common in AAA group (p=0.018). PAF-related strokes had higher NIHSS (p<0.001) and a larger lesion (≥20mm, 81.1%[A-fib] vs. 16.0%[AAA] vs. 46.2%[PFO]; p<0.001). By contrast, AAA-related strokes showed small but multiple lesions scattered in multiple vascular territories (p<0.001). Patients with PFO had subcortical lesions (p=0.029) in posterior circulation (p=0.004).
Multivariate regression analysis revealed that age, NIHSS, hypertension, multiple(≥3) lesions and involvement of multiple vascular territories could differentiate 3 groups (R2=0.6581). We calculated probability for 3 groups and performed external validation.
Conclusion: Patients with cryptogenic stroke showed distinct features which may provide clues for stroke mechanisms. Our data suggested that etiologic work-ups for cryptogenic stroke could be guided by these features.
- © 2012 by American Heart Association, Inc.